Treatment of Hypercalcemia

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Abstract
Comparative effectiveness of six to eight hour infusions of phosphate, sulfate, and hydrocortisone was studied in 22 hypercalcemic patients with neoplastic disease. Mean maximum reduction in serum calcium level with phosphate was dose dependent: 25 millimols, 1.1 mg/100 ml; 50 millimols, 2.44 mg/100 ml; 75 millimols, 4.13 mg/ 100 ml; and 100 millimols, 6.08 mg/100 ml. The reduction was also directly related to the rise in serum phosphate level. Sulfate infusion (38.9 gm) caused an average maximum decrease of serum calcium of 1.87 mg/100 ml. Hydrocortisone (200 mg) produced minor inconsistent changes in serum calcium and phosphate levels. Infusions of phosphate caused reduction in urinary calcium and rise in phosphate level. Both sulfate and hydrocortisone infusions resulted in rises in urinary calcium and urinary phosphate. These studies demonstrate the superiority of phosphate in treatment of hypercalcemia and suggest guidelines for dose selection.